The Use of Placebo as a Provocative Test in the Diagnosis of Psychogenic Non Epileptic Seizures

Psychogenic non epileptic seizures (PNES) are clinical events of psychological nature. Video-electroencephalography monitoring (V-EEGM) is a valuable method for the diagnosis of PNES and may be combined with provocative tests to induce seizures. The use of placebo in provocative tests for the diagnosis of PNES is controversial because of associated deception, and contrasts with the use of truly decreasing epileptogenic threshold techniques such as hyperventilation and photo stimulation. We present a clinical case of a pregnant woman with a past history of refractory epilepsy, admitted in the obstetric department due to unremitting seizures. In this clinical context, non-deceiving provocative tests such as hyperventilation and photo stimulation could be potentially harmful, nevertheless, the use of intravenous saline injection presented as a safer alternative to diagnose PNES and hence obviate an urgent caesarean. This case illustrates a disproportionate risk of causing harm when telling the truth, in comparison with the benefit of avoiding such risk, although deceiving the patient. This is a clinical example of how considerations concerning the use of placebo must be evaluated in an individual basis.     

Gastric MALT lymphoma. A clinico-pathological study of 65 cases. Relationship to Helicobacter pylori

We report 65 cases of MALT gastric lymphomas. HP was looked for with Giemsa and Whartin Starry stains. Immunohistochemistry was done with PAP method. Anti-HP treatment was used in 9 cases. 38 were of low grade of malignancy, 23 were high grade, 4 were high grade with a low grade component. The mean age was 51.5 years, the sex ratio 1.5. Epigastric pain was the most frequent feature (87.7% of cases). Endoscopically, low grade lymphomas presented as unique or multiple ulcerations (55.3% of cases) with antral localisation (52.6% of cases). 60% of our patients were stage IE, of which 61% had low grade lymphoma, 18% were at stage II2E, 10% at stage III and 10% at stage IV. From 23 operated patients, 29% had early lymphoma which was low grade malignant in 71.5% of cases, and 71% had lymphomas which were widely spread beyond the submucosa. HP was found in 63% of cases. Histologic regression of two early lymphomas of low grade malignancy was achieved after HP eradication.     

Enhanced cell growth inhibition following PTEN nonviral gene transfer using polyethylenimine and photochemical internalization in endometrial cancer cells

PTEN is a tumor suppressor gene mapped on chromosome 10q23.3 and encodes a dual specificity phosphatase. PTEN has major implication in PI3 kinase (PI3K) signal transduction pathway and negatively controls PI3 phosphorylation. It has been reported to be implicated in cell cycle progression and cell death control through inhibition of PI3K-Akt signal transduction pathway and in the control of cell migration and spreading through its interaction with focal adhesion kinase. Somatic mutations of PTEN are frequently detected in several cancer types including brain, prostate and endometrium with more than 30% of tumor tissue specimens bearing PTEN mutations and/or deletions. Because of its high frequency of mutations and its important function as tumor suppressor gene, PTEN is a good candidate for gene therapy. Inducible expression of PTEN has been also reported. In cancer cells bearing PTEN abnormalities, the reversion of PTEN function by external gene transfer becomes more and more investigated in cancer treatment research. Several technologies including the photochemical internalization (PCI) and aiming at improving the transfection efficiency have been reported. PCI is an innovative procedure based on light-induced delivery of macromolecules such as DNA, proteins and other therapeutic molecules from endocytic vesicles to the cytosol of target cells. PCI has been reported to enhance the gene delivery potential of viral and nonviral vectors. The present study was designed to evaluate the influence of photochemical internalization on polyethylenimine (PEI)-mediated PTEN gene transfer and its effects on the cellular viability in Ishikawa endometrial cancer cells bearing PTEN abnormalities. PCI was found to significantly (P < 0.01) enhance PTEN mRNA expression (4.2 fold increase). Subsequently, following PEI-mediated PTEN gene transfer, the restoration of the PTEN protein expression was observed. As a consequence, significant cell growth inhibition (44%) was observed in Ishikawa endometrial cells. Using PCI for PEI-mediated PTEN gene transfer was found to further enhance PTEN mRNA and protein expression as well as PTEN-related cell growth inhibition reaching 89%.     

1,1, 1-trichloroethane-induced chronic active hepatitis

1,1, 1-trichloroéthane is derived from carbon tetrachloride and has been widely used as an industrial solvent since 1954, because of its supposed lack of toxicity. However, several cases of central nervous system toxicity and heart disorders due to intoxication by 1,1, 1-trichloroéthane have been reported. Cases of liver injury are infrequent, with less than 10 cases, unlike 1,1, 2-trichloroéthane that it replaced. We report a case of hepatotoxicity probably due to 1,1, 1-trichloroéthane exposure, characterized by an original pathologic feature of chronic active hepatitis.     

A programmed autologous transfusion. A study of 47 patients

From December 1994 to January 2002, 44 among the 47 patients proposed have been integrated in the protocol of programed autologous transfusion. 18 patients were belonged to the male sex and 26 others belonged to the female one. The average age was 53.2 years (range 15-82 years old). 39 among the patients admitted in the protocol had an orthopaedic pathology. The protocol has associated the teams of surgery, of anesthesia and of transfusion and has occurred in the respect of the regulation (circular 91/2000). The blood taking have led to a significant modification of the hemoglobin rate (average decrease of 2 g/100 ml), of hematocrit (average decrease of 6.1%) and of the rate of platelets (average increase of 29,324 platelets/mm3). On the other hand, a transfusional complement by the concentrated homologous red corpuscles was necessary for 2 patients (2/40).     

HLA-A,B,C, Bf and glyoxalase I polymorphisms in a sample of the kabyle population (Algeria)

HLA (A,B and C) gene and haplotype frequencies were determined in 44 Berber families from the Kabyle tribe. The Bf and Olo polymorphisms were also defined and the haplotypes were deduced from these family data. The main association (A1, B8, BfS; A29, B12, GIo²; Aw33, B14, BfS, GIo¹; Cw5, B18, BfF1; A1, Bw17) showed the relationship between the populations from the southwest of Europe, and this population. Another association, A11 and Bw21, was found also in Twareg, which are probably of the same origin.     

Performance of the GenoType MTBDRsl V 2.0 for detecting second-line drugs resistance of Mycobacterium tuberculosis isolates in Tunisia

Rapid detection of the second-line drug (SLD) resistant tuberculosis (TB) strains is challenging to prescribe an immediate adequate treatment and limit the transmission of SLD resistant strains.The study aimed to evaluate the performance of GenoType MTBDRsl V2.0 compared to phenotypic drug susceptibility testing (pDST:MGIT960) to detect resistance to SLD of Mycobacterium tuberculosis (MTB) isolates in Tunisia, between May 2015 and December 2019.As a matter of fact, 103 rifampicin-resistant and multidrug-resistant MTB strains were included. Discrepancies between pDST and MTBDRsl were solved by whole genome sequencing.Compared to pDST, MTBDRsl V2.0 showed a sensitivity of 92.8% (68.5%–98.7%) in detecting resistance to fluoroquinolones. As for second-line injectable drugs, it presented a sensitivity of 80.0% (49.0%–94.3%). MTBDRsl had sensitivities of 100.0% (67.5%–100.0%), 75.0% (40.9%–92.8%) and 100.0% (60.9%–100.0%) respectively for kanamycin, capreomycin and amikacin. The specificity was 100.0% for all the drugs evaluated.As for diagnosing XDR-TB, it had a sensitivity of 57.1% (25.0%–84.1%) and a specificity of 100.0% (96.1%–100.0%).MTBDRsl V2.0 showed a high performance in detecting SLD resistance with a short turnaround time compared with pDST, which made it possible to start an early treatment and to maintain a low prevalence of SLD resistance and XDR-TB in Tunisia.     

Bone homeostasis in growth hormone receptor-null mice is restored by IGF-I but independent of Stat5

Growth hormone (GH) regulates both bone growth and remodeling, but it is unclear whether these actions are mediated directly by the GH receptor (GHR) and/or IGF-I signaling. The actions of GH are transduced by the Jak/Stat signaling pathway via Stat5, which is thought to regulate IGF-I expression. To determine the respective roles of GHR and IGF-I in bone growth and remodeling, we examined bones of wild-type, GHR knockout (GHR(-/-)), Stat5ab(-/-), and GHR(-/-) mice treated with IGF-I. Reduced bone growth in GHR(-/-) mice, due to a premature reduction in chondrocyte proliferation and cortical bone growth, was detected after 2 weeks of age. Additionally, although trabecular bone volume was unchanged, bone turnover was significantly reduced in GHR(-/-) mice, indicating GH involvement in the high bone-turnover level during growth. IGF-I treatment almost completely rescued all effects of the GHR(-/-) on both bone growth and remodeling, supporting a direct effect of IGF-I on both osteoblasts and chondrocytes. Whereas bone length was reduced in Stat5ab(-/-) mice, there was no reduction in trabecular bone remodeling or growth-plate width as observed in GHR(-/-) mice, indicating that the effects of GH in bone may not involve Stat5 activation.     

Cystic adventitial disease of the popliteal artery with unusual spontaneous regression: A case report with literature review

This report highlights the case of cystic adventitial disease of the left popliteal artery in a 45‐year‐old male patient. Imaging modalities confirmed the diagnosis and high resolution MRI found a cystic connection to the adjacent knee joint. The evolution was unusual with spontaneous regression of the symptoms.     

Intradiploic hematoma: report of two cases and review of literature

Diploic hematoma is an uncommon lesion which develops generally after minor head trauma. Only seven cases have been published so far and we are reporting two new cases of diploic hematoma in infancy. The diagnosis was made by computerized tomography and confirmed by histology. Diploic hematoma should be considered as part of the differential diagnosis in case of with a diploic lesion.